“I had trouble with my sleep; trouble with perception; trouble with light, with sound.”
The concussion that took Canada and former Clermont lock Jamie Cudmore to the brink of retirement before the 2015 World Cup has prompted him to launch the Rugby Safety Network (RSN) – a foundation to raise awareness and understanding of concussion.
“I’ve had a few concussions,” Cudmore explained. “But the big one was last year in the semi-final of the European Champions Cup. I was taken off the field and went through a head injury assessment (HIA). I was told that I had failed, but then was allowed to return to the field five or 10 minutes later.”
Cudmore – somehow – finished the semi-final against Saracens in St Etienne and lined up for Clermont again in London two weeks later, for the final against Toulon.
He said: “It was too early to come back. The first major contact I made – it wasn’t a hit to the head, I went to make a tackle – was enough to send me off the field with ‘second-impact syndrome’. I came back and then went off again, and then a third time in the second half. After vomiting, I was still allowed to come back.”
Vomiting is a ‘red flag’ symptom of concussion, indicating that a player needs medical assessment. Other symptoms include confusion and drowsiness. Cudmore suffered them all last summer as he endured a month of mood swings, irritability, headaches and insomnia.
The 37-year-old has spoken previously of the concussion that nearly ended his career. Before the World Cup in 2015, he told reporters at a press conference: “It was very scary. The whole month of June I was sitting on my couch. I couldn’t watch TV, I couldn’t really do anything. I was stuck between the World Cup and retirement.
“I had all kinds of symptoms: headaches, being irritable, tired when you shouldn’t be tired, then being really tired and not being able to sleep.”
Cudmore’s foundation launched quietly earlier this summer and he is determined to spread the message about the dangers of concussion. Recalling his difficult recovery, he said: “It was a pretty tough time. I didn’t really know the rules around concussion – and I don’t think the club really knew, either.
“That’s why we’ve come to this point, with RSN, so that we can change the thinking behind how concussions and head injuries are treated.”
World Rugby’s guidelines for players with concussion say players should not return to the pitch until they have gone through a graduated return-to-play programme. It includes a mandatory minimum rest period, followed by a monitored training process.
For amateur and younger players, the rest period before they can start training again is three weeks. For professional players, who have access to high-level medical care, this period can be as short as one week – though authorities are reportedly considering changing the rules.
Cudmore is concerned that the money in the professional game, especially in France, has increased pressure on players to take to the field too soon after a concussion, despite risks to their long-term health.
He said: “You’ve got players who are are paid a lot of money and they need to perform. You’ve got clubs worried about the bottom line and about stadiums being filled – about winning games and not being relegated and reaching the play-offs.
“Clermont were knocked out of last season’s European Cup before the quarter-finals. That was a big-money loss. If clubs can ensure they have their best players on the pitch at all times, they’re going to do that.”
He predicted that clubs could face legal action if concussion is not taken as seriously as it should. “If clubs do not take the best care of their players – their employees – there’s definitely going to be some waves around the different unions.”
In the US, degenerative brain disease chronic traumatic encephalopathy (CTE), found in athletes who have a history of repetitive brain trauma, is the talk of the NFL. Cudmore believes the condition could be increasingly linked to rugby. “Players can have 10-year plus careers. In a career that long you can easily have five, six, even 10 concussions.
“It’s an impact sport. There is that risk of developing CTE. I have friends in Canada who have problems now after playing rugby for 10 or 15 years. They’re now 45 to 55 years old and have problems from a lot of impacts to the head.
“I don’t think it’s the same level of problem as American Football. But there are collisions in rucks, collisions in tackles where players are hit on the head. Or they get low in the tackle and get a knee in the side of the head, or they get their head on the wrong side.
“In those instances, where a player takes a hit or is knocked out, the powers that be have got to make sure that player’s best interests are taken into account.”
Cudmore’s experiences in France have led him to believe that the game there lags behind other nations. He said: “I see a lot of things happening after the fact. After the fact is better than not at all – so things are changing. But it’s too bad that concussion protocols have taken so long to be put properly in place.”
According to a three-year injury study published by the Ligue Nationale de Rugby, which runs the Top 14, the number of players forced off the field with concussion was stable at 36 to 38 between the start of the 2012/13 season and the end of the 2014/15 campaign, with an average of two cases each weekend.
Cudmore pointed to another concussion that shocked French rugby at the time – when Toulouse centre Florian Fritz left the field with a head injury midway through the first half of a Top 14 play-off game in 2014, but was patched up and returned briefly to the pitch shortly before half-time.
He said: “If you have to be helped off the field by medical staff and you have blood all over your face, as a doctor you’ve really got to ask the question: ‘what is best for my patient – my player?’.
“The fact Florian had to sit down several times as he walked off the field should have been enough to know that he should have been taken off. ‘Player welfare’ is a big catchphrase for World Rugby, but I don’t see the French keeping up with the rest of the world.
“It’s not for the player to say he should go off. Players will always say they can keep going. The medical staff’s first job must be to the patient – the player. Doctors’ ethics put the patient first. It’s not a question of the team, or what the player or anyone else thinks. If someone is injured they need to be protected.”
The RSN foundation will focus on awareness and education. “The most important thing for us is getting out to clubs and schools, so that coaches, doctors, managers know that, when there’s issue with any of their players, the first thing to do is get the player off the field and ascertain what the injury is. Has it been a stinger? Is it a concussion? Could the player have a brain injury? It’s vital that the player is taken out of danger.”
“Players will always say ‘just rub some dirt on it’. It’s up to the coaches, educators, doctors and management to decide that, if they suspect concussion or brain injury, that players’ health – their long-term health, most importantly – is taken into account.”
Education, for players, as well as coaches and trainers, should start as soon as possible, Cudmore said. “Kids need to know they’re not weak if they don’t want to play because they took a knock to the head. They must be taught at a young age that concussions can happen and that it’s okay to say: ‘No, I don’t feel right, I’ve got to get off the pitch’.
“More importantly, coaches and educators should be able to recognise possible concussions and say ‘I suspect that my player has had a knock and I need to pull them out’.
“There is impact in rugby. You can’t take that away. I don’t want to stop anyone playing the game and I love a good hit as much as the next guy. But if somebody does get some kind of head injury or concussion, they need to be protected.”
James Harrington, Pundit Arena